Endoscopic multiple ligating clip applier with rotating shaft

ABSTRACT

An endoscopic clip applying system as described which contains a venting system and a clip applying support system which prevents closure of the mechanism before firing. The applier&#39;s jaws are spaced apart no further than the width of the applier shaft, even when holding a clip. Also, the system ensures proper loading of the clips and prevents them from falling out during loading. Further, the system describes an easily manufacturable, positively opening system which has minimized size requirements. Furthermore, a lock-out mechanism is provided so that the mechanism may not be inadvertently fired. The shaft resists excessive torque as well as holds the clip in place during firing. There are provisions for sealant and non back-up of the clips, as well as features which make the clip properly placed for closure. In an alternate embodiment, the clip applier shaft rotates about its handle mechanism.

This invention is a continuation-in-part of Ser. No. 680,215, filed Apr.4, 1991, entitled "ENDOSCOPIC MULTIPLE LIGATING CLIP MECHANISM."

FIELD OF THE INVENTION

Generally, this invention relates to ligating clip appliers. Morespecifically, this invention relates to endoscopic ligating clipappliers. Most specifically, this invention relates to endoscopicligating clip appliers, where the applier is capable of placing down asequential number of clips from a multiple clip applying cartridge.

BACKGROUND OF THE INVENTION

There have been many advances in recent years in the field of endoscopy.Many of these advances have come due to the increased versatility ofendoscopic staple and clip applying mechanisms. These mechanisms areplaced through the cannula of an endoscopic trocar so that tissue may becut, stapled or ligated. With use of these endoscopic stapling andligating mechanisms, there have become available means for theproliferation of endoscopic ligating procedures.

With the advent of these devices, however, there have been certain notedinadequacies. Many of these inadequacies have become perceived solelybecause of the newness of the endoscopic procedures. Thus, there hasbeen a great opportunity for the discovery of new needs and desires ofeach individual surgeon, and therefore an explosion in the necessity tomeet these requirements.

For instance, there has been perceived a need for venting such anendoscopic applier, in order to equalize pressures within the instrumentand to provide a path of least resistance for fluid flow within theinstrument. The equalization of pressures minimizes the possibility offailure of the instruments.

In addition, there has been a perceived need for adequate clip advancingmechanisms in order to both longitudinally (along the long axis of theinstrument) and transversely support both the clip closing mechanism andthe clip during such surgeries.

Also, there has been perceived a need for a mechanism to vary the gap ofa ligating clip when closed within the mechanism.

There is yet another perceived need for a mechanism which guaranteesthat the jaws of the instrument are open when a clip is fed into thesejaws. This mechanism insures clip presence during ligating procedures.

There is yet another perceived need for a mechanism to lockout thefiring mechanism instrument after the last ligating clip in thecartridge of clips has been fired.

Yet another perceived need is for a restricting means to minimizeproximal movement of the clip during application into a vessel. Thislimitation of movement maintains the ligating clip within the properforming area of the jaws during ligation.

One additional need is to create a resistance to the torque acting onthe endoscopic applier shaft. Resistance of such torque minimizes anytransverse deflection of the endoscopic applier tip during usage. Suchtorque resistance promotes clip placement accuracy.

Still another perceived need is to create smaller jaw spacing, whichallows the usage in a smaller cannula during endoscopic procedures. Oneadditional problem encountered in the resolution of this problem is thatone must minimize the spacing of the jaws, while still compensating forthe torques created during jaw closure.

Yet another perceived need is for a system which minimizes thepossibility of double feeding of clips into a clip applier jaws. Such asystem may be perceived as the use of a series of valves and springs inorder to properly place only one clip within the jaws of the instrumentat any one time.

One additional need is for a mechanism which seals an endoscopic clipapplier, to prevent the gross loss of pneumoperitoneum, duringoperations. Such sealing is necessary to maintain pneumoperitoneumthroughout the procedure.

One further perceived need is for a method wherein the synchronizedfeeding of clips into the jaws of an applier is coordinated with theopening and closing of these jaws during use.

Another final perceived need is for a mechanism which prevents backup ofa clip about to be fired within such an endoscopic clip applier.

Therefore, it is to be realized that while there currently exist certainendoscopic clip appliers, it continues to be still important to improveon these appliers in many various areas where there are perceiveddeficiencies or inadequacies.

SUMMARY OF THE INVENTION

Accordingly, it is an object of the invention to provide an endoscopicmultiple ligating clip applier with an adequate venting system tomaintain the instrument from functional failure.

It is yet another object of the invention to provide a multiple ligatingclip mechanism which provides for clip closure without the threat ofdropping the clip from the instrument into the wound site.

It is yet another object of the invention to provide a clip closure camchannel for a multiple ligating clip instrument, so that closure of theligating clip is improved.

It is yet another object of the invention to provide for a feature whichretains the jaws in a "positive open" position, so that a clip will befed into a pair of open jaws. This improves the reliability andperformance of the mechanism.

It is yet another object of the invention to provide for a lockoutmechanism which causes the instrument to be locked out once the lastclip from the magazine is fired.

It is yet another object of the invention to maintain the clips firmlywithin the jaws during closure. This enables the user to be assured ofmore precise spacing of clip legs, and results in an improved clipclosure within the instrument.

It is yet another object of the invention to provide for a torqueresisting shaft for a multiple clip applier which minimizes transversedeflection of the tip of the instrument. Such minimunization promotesimproved clip placement and accuracy during firing.

It is yet another object of the invention to provide within a multipleclip firing instrument, an anti-torque feature on the jaws of thisdevice. This feature should be designed to allow the size of the jaws tobe minimized, while still maintaining and providing adequate clipclosure characteristics.

An additional object of the invention is to provide for an endoscopicligating clip applier which permits the user to place a clipautomatically, through a trocar cannula, without having to load a clipafter placement of the mechanism in the endoscopic cannula. This willdepend on the user's ability to keep the jaws spaced apart uponinsertion into the cannula with a clip therein.

Yet another object of the invention is to provide for a clip feedingsystem which improves the clip feeding reliability by minimizing thepossibility of double feeding of the clips into the jaws.

It is yet another object of the invention to provide for a sealingsystem within the endoscopic multiple clip applier so that it maintainspneumoperitoneum throughout use of the system.

One other object of the invention is to provide a timing mechanism foran endoscopic multiple clip applier wherein it is assured that a clip isfed from an array of clips forming a clip stack into the jaws of themechanism during the time between when the jaws are spaced apart so asto be able to accept such a clip, and yet before the instrument has beenfully released to its open or "ready to fire" position.

It is yet another object of the invention to provide for a tissue stopwhich prevents tissues or vessels held within the clip applier frombeing improperly positioned on the instrument. Such a mechanism isadvantageous in order to promote secure clip closure and placementwithin the context of a multiple fire ligating clip mechanism.

These and other objects of the invention are provided for in anendoscopic ligating clip device which contains a firing mechanism heldremotely from an endoscopic clip applying portion by a long solidcannula. The device is created so that the clips are applied in oneorientation, but it is understood that the clip applier can be rotatedto advantageously orient the system. Within the clip applying mechanismthere is described a venting system which comprises a channel throughwhich the device may be vented. This helps insure adequate firing withinthe system. There is also described a feed bar support mechanism whichcontains a pair of protrusions which prevent the deflection of the clipapplier jaws during its insertion into the cannula. Furthermore, thereis described a cam channel mechanism which provides a uniform closingforce upon the ligating clip held within the jaws. A tab within the camchannel prevents the jaws from closing, so that these jaws may assurablyreceive a new clip after the instrument has been fired to place a cliparound tissue.

Other novel features are provided in this system. First, there is amechanism comprising a lever which falls into the firing path of thedevice so that the instrument cannot be fired after the last clip hasbeen fired from the mechanism. Second, a finger located on the clipapplying mechanism is described, which securedly holds the clip about tobe fired in place on the jaws of the instrument. Third atorque-resisting shaft is placed on the instrument, to preventtransverse deflection of the tip of the instrument during firing.

Another unique feature of the instrument is located in the jaws, whichprovide multiple contact points during firing, minimizing deflection inthe arms of the jaws, enabling proper closure of the clip. Thisminimization of deflection provides for more consistent and improvedclip closure. A clip feeding escapement system provides that only oneclip is actually inserted within the open jaws after the previous cliphas been fired. Furthermore, there is a sealing system provided for inthe mechanism which adequately provides the sealing of pneumoperitoneum.Also, there is located on the shroud of the instrument a v-shaped notch,which helps maintain the tissue on the jaws of the instrument. Thisnotch helps secure proper position of the tissue for firing of theinstrument and clip closure.

Furthermore, the clip applier presents a streamlined profile, enablingone to emplace a clip between the jaws of the applier, and then placethe applier in a trocar cannula. Because the clip reliably stays inplace, this allows the user to avoid loading of clip within the trocarcannula. Also, because the clip applying mechanism is presented in analternate rotatable embodiment, this allows the user to orient the clipapplier at any desirable position.

This device has been described in connection with a number of variousfeatures contained in its embodiment. These features will be betterunderstood when taken in connection with the attached DetailedDescription of the Drawings and described in connection with thefollowing Detailed Description of the Invention.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of the left hand side of the endoscopicmultiple clip applying instrument of this invention;

FIG. 2 is a side plan view of the instrument of the invention in theopen position;

FIG. 3 is a side plan view of the instrument of the invention in theclosed position;

FIG. 4 is a perspective view of the instrument of the invention insertedthrough a trocar;

FIG. 5 is an assembly view of the handle of the invention;

FIG. 6 is a partial cut-away view of the handle of the invention in itsrelaxed position;

FIG. 7 is a partial cut-away view of the handle of the invention in itsfiring position;

FIG. 8 is an assembly view of the tubular endoscopic portion of theinstrument of the invention;

FIGS. 9, 10 and 11 are sequential plan views of the clip as placed inthe jaws of the invention when in the open, closing and closed positionsrespectively;

FIG. 12 is a longitudinal cross-sectional view of the invention takenacross lines 12--12 as seen in FIG. 2;

FIG. 13 is a cross-sectional view of the invention taken along lines13--13 as seen in FIG. 1;

FIG. 14 is a cross-sectional view as taken across lines 14--14 of FIG.1;

FIG. 15 is a cross-sectional view of the invention describing the camchannel mechanism taken across lines 15--15 of FIG. 2;

FIG. 15A is a cross-section view taken across lines 15A--15A of FIG. 15;

FIG. 16 is a cross-sectional view of the invention describing thehandle-latch combination;

FIG. 16A is a cross-sectional view of the invention taken across lines16--16 of FIG. 3 emphasizing the lockout mechanism used in theendoscopic clip applier;

FIG. 16B is a cross-sectional view of the invention taken across lines16--16 of FIG. 3, emphasizing the rearward retention mechanism for theclip applier in the open-state with an unformed clip of the invention;

FIG. 16C is an identical view as FIG. 16B, except that it demonstratesthe jaws in a closed state, with a formed clip;

FIG. 17 is a plan view of the jaw component of the invention;

FIG. 18 is a view of the jaw as seen in FIG. 17 when in the closedposition;

FIG. 18A is a cross-sectional view across lines 18A--18A of FIG. 18;

FIG. 18B is a cross-sectional view across lines 18B--18B of FIG. 18;

FIG. 19A is a cross-sectional view of the clip feeding escapement systemof this invention across lines 19A--19A of FIG. 1;

FIG. 19B is the view of FIG. 19A in the closed position;

FIG. 20 is a partial cross-sectional view of the shaft assembly acrosslines 20--20 as seen in FIG. 1;

FIG. 21 is a cross-sectional view of FIG. 20 as seen across lines 21--21of FIG. 20;

FIGS. 22A, 22B and 22C are sequential views of the clip feed timingmechanism of the invention;

FIG. 23 is a perspective view of the clip applying mechanism of thepresent invention;

FIG. 24A is schematic of the rotational portion of the mechanism of FIG.23 in a non-firing position;

FIG. 24B is a schematic of the mechanism in FIG. 23 showing the rotatingportion in a firing position;

FIG. 25 is a top plan view of the rotating portion of the mechanism ofFIG. 23;

FIG. 25A is a cross-sectional view of the angular positioning of thedetents of the rotating mechanism as seen in FIG. 25; and

FIG. 26 is a cross-sectional view of the rotating mechanism of FIG. 25as seen across lines 26--26 of FIG. 25a.

DETAILED DESCRIPTION OF THE INVENTION

This invention is better disclosed by an endoscopic multiple ligatingclip application mechanism 1 can be seen in FIGS. 1-22. As better seenin FIGS. 1, 2, 3 and 4, this multiple ligating clip mechanism 1 isuseful for applying clips through a surgical trocar 100. As seen in FIG.4, the ligating clip mechanism 1 is applied through the cannula 105 of atrocar 100, so that a vessel can be occluded or tissue can be clamped.The mechanism applies the forwardmost clip 8 of a series of clips bymeans of jaws 11 which are fired remotely by a trigger 25. As seen inFIGS. 2 and 3, the trigger 25 is compressed, causing the jaws 11 toclose, and squeezing a ligating clip 8 therein. After closing theforwardmost clip 8, the jaws 11 are released and there is loaded anotherclip 8 in its place. As used herein, jaws 11 containing jaw arms 11a,11b, will be used interchangeably.

As better seen in FIGS. 4 and 9, it is an intention of this clip appliermechanism 1 to present a pair of jaws 11 which are maintained in asmooth and streamlined profile around ligating clip 8. Specifically, anintention of this invention is to allow the jaws 11 to fit aroundligating clip 8 so that they are relatively the same dimensional widthas the diameter of the barrel which forms support tube 15 of theligating clip mechanism 1. In this way, the clips 8 can be emplacedbetween jaws 11 outside of the cannula 105 of trocar 100. As will belater explained, because the jaws 11 reliably maintain the clip 8 firmlyheld in place between each of the jaws 11, the user can reliably placethe clip 8 between the jaws 11, and then insert the entire instrumentincluding tube 15 into cannula 105.

In contrast to other systems, there is no need to load a clip 8 afterinsertion of the jaws 11 within the cannula 105. The positioning of jaws11 allows its insertion in an open condition with clip 8 maintainedtherein into cannula 105 of trocar 100. This is in direct contrast toformer systems wherein similarly configured jaws must be broughttogether to roughly the size of this mechanism's open jaws 11, in orderto fit within the cannula 105 of a typical surgical trocar 100. Thisadvancement allows this particular clip firing mechanism 1 to be fullyautomatic rather than a mechanism which must be loaded separate from thefiring sequence.

As better seen in FIGS. 5, 6 and 7, there is described handle halves 16,28 which contain the trigger 25 mechanism for firing the device. Thehandle halves 16, 28, surround the firing mechanism and afford a pivotpoint 110 around which trigger 25 rotates. Trigger 25 is associated witha former plate 22 and a feeder link 23. As seen on the right hand sideof FIG. 5, feeder link 23 is attached to the trigger 25 in that pivot113 fits in slot 111. Further, feeder link 23 abuts feeder plate 24 tohold it positionally within handle halves 16, 28. Feeder plate 24 isconnected to return spring 27. Feeder plate 24 contains post 24a whichis in turn connected to a post 22a on former plate 22. Thus, when thetrigger is fired, the former plate 22 is pushed forward. Pivot 113 ontrigger 25 slides in channel 115 in handle half 16 and causes slot 111to be urged toward the rear of the instrument. Slot 118 on feeder link23, in turn causes feeder plate 24 to be urged to the rear of theinstrument. Simultaneously trigger 25 rotates so that slots 114 causesdowel pin 26 to slide in slot 112 of plate 24. Also dowel pin 26 urgespoint 116 in former plate 22 forward, as it slides within slot 117 inhandle half 16. When the trigger 25 is released, the tension on returnspring 27 causes the trigger 25 to return to original position. Thismotion causes feeder plate 24 (through post 24a) and former plate 22(through post 22a) to be similarly effected, so that trigger 25, dowelpin 26, and former plate 22 are returned to their non-stressedpositions. Dowel pin 26 maintains feeder plate 24 so that is assumes aplace on right handle half 16. An anti back-up lever 19, lost motionlever 18, latch 17, and torsion spring 20 and pre-cock trigger 21 willall be further described as part of this invention.

When the trigger 25 is activated, the former plate 22 is caused to moveforward so that cam channel 12 connected to former plate 22 withinsupport tube 15 is moved forward. This actuates the endoscopic clipapplying mechanism. As seen in FIG. 8, the feed bar 9 and cam channel 12surround floor 10. These mechanisms are sealed between lower shroud 13and seal cap 14 within the support tube 15. Inserted within cam channel12 is jaw 11. This jaw will close about a ligating clip 8 to seal tissueor vessels.

Held between support tube 15 and clip track 4 are feeder spring 5, locklever 6, feed shoe 7, and a series of clips 8. The clip track 4 iscapable of advancing forward a series of clips and loading them withinthe arms of jaw 11. A lifter spring 3 is held in place over clip track 4by top shroud 2, and will place the first clip 8A of a stack of clips 8into the plane of feed bar 9 to be positioned into jaws 11. Also, theseal cap 14 and lower shroud 13 hold cam channel 12, floor 10 and feedbar 9 in place within the support tube 15.

In operation, the trigger 25 is fired and former plate 22 causes camchannel 12 to move forward. Cam channel 12 encloses jaws 11 to seal aclip 8 around tissue. After trigger 25 is released, cam channel 12retracts so that jaws 11 open. The magazine of clips 8 is advancedforward so that another clip 8 is held within jaws 11. This occurs whenspring 27 is released, causing feeder plate 24 to advance. This in turncauses feed bar 9 to advance the first clip 8a from the stack of clips 8which has been positioned in the path of the feed bar 9 by spring 3 intojaws 11. This operation can best be seen by observing FIGS. 9, 10 and 11in conjunction with FIGS. 6 and 7. Of course, each of the mechanisms asdisclosed by this invention will be further described herein.

Specifically, it is to be noted that the orientation of clips 8 istransverse to that of the orientation of the handle portion of theinstrument 1. In this way, the user is able to grip the trigger 25 onthe handles 16, 28 of the instrument 1 so that the user's hand is heldparallel to the plane on which the clips are fired. This affords a moretypical reference point for the user, so that it is more comfortable foroperation of the instrument.

Now, each of the various features of the clip applying mechanism will bedescribed. The first feature is a venting system for endoscopicallyapplying these clips. As seen in FIG. 12, there is located a vent 120 onthe outside of the instrument. This vent 120 is attached to an openchannel 122 within the lower shroud 13 within the support tube 15.

Open channel 122 is connected to a hole 124 in the lower shroud 13. Thisallows fluid passage between tube 15 and lower shroud 13. This hole inlower shroud 13 affords fluid passage between the upper portion 126 ofthe instrument and the inner channel within lower shroud 13. This openchannel 122 within support tube 15 runs along the longitudinal axis ofthe support tube 15 and provides a path of least resistance for fluidflow between the abdominal cavity and the inside of the instrument 1,such that pressure is capable of being equalized in the instrument. Thehole 124 in the lower shroud 13 at the end of this channel 122 providesa venting path to the upper portion 126 of the shaft assembly. Fluidheld at higher pressures before insertion, is therefore vented from theinstrument 1. The instrument is much more capable of functioning underbetween 10 and 15 mm mercury pressure. Pressure is equalized across theentire instrument, and a path of least resistance is provided. In thisway, the likelihood of functional failures of the instrument when usedoperatively is reduced.

Furthermore, as seen in FIGS. 13 and 14, there is also disclosed areinforcement or support mechanism for the endoscopic multiple clipapplier. This reinforcement or support mechanism provides longitudinalsupport for the ligating clip 8 during application onto tissue, andtransverse support of the jaws 11 during insertion through the cannula105 of the trocar during endoscopic surgery. This reinforcement schemeprovides for a more reliable system. As seen in FIGS. 13 and 14, whenthe instrument jaws 11 are opened the ligating clip 8 is positionedbetween the jaws 11A, 11B of the instrument. The feed bar 9 is advancedcompletely forward. When the instrument is inserted through a cannula ofa trocar and applied to tissue it is important that the jaws areprevented from closing. As seen in FIG. 14, there are outboardprotrusions 132 on the feed bar 9. These outward protrusions 132 contactthe angled arms 134 of the clip 8 in the jaws. Also, the feed bar 9 hasa tapered outer edges 130 which contacts the inner edges 136 of the jaw11.

Thus, jaws 11A, 11B are prevented from being squeezed transverselyduring insertion through a cannula 105. The outboard protrusions 132prevent the clip 8 from moving longitudinally during insertion, and theouter edges 130 of the feed bar 9 prevent the inadvertent jaw closureduring insertion. This aspect advantageously promotes improved clipclosure and prevents dropping of a clip from the instrument into thewound site during usage.

Another feature is the clip closure cam channel 12 used in thisinstrument. Cam channel 12 helps close the jaws 11 of the ligating clipinstrument. The cam channel mechanism 12 travels longitudinally alongthe axis of the tubular support tube 15 of the instrument. The camchannel 12 lies in the longitudinal axis of the jaws 11. The distal end140 of the cam mechanism is rectangular and cross sectioned, as can beseen in FIG. 15. As in FIG. 15A, on the anterior surface of the camchannel 12 there is a dovetail joint 142, 142A, which holds the camchannel 12 together mechanically. This dovetail mechanical lock reducesthe transverse (side-to-side) deflection of the cam channel 12 duringclip formation. In this way, while the longitudinal motion of the camchannel 12 takes place, transverse motion of the cam channel 12 isprevented. Therefore, the dovetail mechanical lock 142, 142Aincorporated into the cam channel 12 improves the dimensional stabilitycam channel 12 and improves the reliability of closure of the ligatingclip 8.

As also seen in FIG. 15, there is described a pair of tabs 144 in thecam channel 12. These tabs 144 are bent at the distal end of the camchannel 12 and are oriented perpendicularly through the longitudinalaxis of the jaws 11 containing containment arms 11A, 11B of theinstrument 1. When arms 11A, 11b, are open, the outer edges of the tabs144 rest on the arms of 11A, 11B of the jaws 11, preventing them frombeing moved inwardly toward each other, as during closure of themechanism. It will be noticed that the profile forming the maximum widthof jaws 11A, 11B is no greater than the thickness of support tube 15which describes the external diameter of the shaft of the instrument100, thus enabling a clip to be loaded within the jaws and then insertedthrough a trocar cannula, as seen in FIGS, 2 and 15. When there is aligating clip 8 closed within the jaws 11, the cam channel 12 retractsfrom the forming site and the edges of the tabs 144 again contact theedges of the jaws 11, forcing the jaws 11 outward. This guarantees thatthe jaws are open to receive a clip. Clip feeding reliability of theinstrument is increased, while not compromising the process of clipclosure.

As seen in FIG. 16A, there is also described in this instrument apivoting lock-out lever 6, which is attached to the feeder shoe 7. Thelever 6 pivots upon contact with top shroud 2 into the path of the feedbar 9, as seen in FIG. 16A. This lever 6 when downwardly pivoted, asseen in FIG. 16a, prohibits the complete forward motion of the feed bar9. This then causes the biased latch 17 to engage wall 150 of the formerplate 22, seen in FIG. 16. Therefore, this multiple redundant systemallows for locking of the instrument after the last clip 8 is fired atthe forward end of the instrument by the jaws 11, (by biased latch 17)as well as at the rearward end of the instrument by lever 6. Thelock-out lever 6 pivots into place only when there are no remainingclips 8 in clip track 4. Had there been a remaining clip 8, the feederspring 5 would not have been able to bias feed shoe 7 to clear the pathfor the lock-out lever 6, such that lever 6 is caused to pivot into thepath of the feed bar 9. When this locking out by lever 6 occurs, thefeed bar is prevented from completely moving forward and therefore thebiased latch 17 engages the wall 150 of the former plate 22.

Also, as seen in FIG. 16B, there is described a mechanism that minimizesthe rearward movement of a clip 8 in the applier during application ontothe vessel. It is also capable of maintaining the clip 8 in its properforming area throughout complete closure of the mechanism. Thismechanism comprises the floor 10 held within support tube 15. The floor10 protrudes into the longitudinal plane of the clip forming area 160 ofthe jaws 11A, 11B of the instrument. A clip retaining finger 156 on thefloor 10 is provided with a perpendicularly bent tab 154 at its distalend, as seen in FIG. 16B. This retaining finger is unitary to the floor10 and is also biased so that it is parallel with the longitudinal planeof the jaw clip forming area 160. Initially, a clip 8 is held in placeby end 152 of feed bar 9. Distal tab 154 of the finger 156 is positionedperpendicularly to the forming area such that the tab minimizes therearward movement of the clip 8 within the jaws 11A, 11B. As the jawsclose, the floor 10 is ramped out of the plane of the clip forming areaby forward motion of cam channel 12. Yet, throughout closure of the clipand ramping of the floor 10, the bent tab 156 of the clip retainingfinger remains in the plane of the clip 8 and clip forming area 160 ofthe jaws 11A, 11B and is positioned behind the apex of the clip 8. Thisis better seen in FIG. 16C. Therefore, the movement of the clip 8 asheld within the jaws 11 is always controlled and the finger 156 and tab154 of the floor 10 constantly remain in the plane of the forming of aclip 8.

As may be seen in FIG. 8, support tube 15 is torque resistant. That is,the support tube 15 is cylindrical The tube ends near the distal end ofthe instrument, and close to the clip forming jaws 11. Support tube 15is connected to the top shroud 2. The combination of these elementsprovides the necessary resistance against lateral motion of jaws 11 toallow the mechanism to properly form a clip 8. Because the material fromwhich the support tube 15 is made is nonresilient, the stability of theinstrument is increased and this helps increase the placement accuracyof a clip 8.

The jaw member 11 includes a pair of spaced apart arms 170 that definejaws 11A, 11B. The jaws 11A, 11B have a distal end portion and aproximal end portion. The distal end portions include clip receivingchannels for receipt of a surgical clip therein. The channels include anend wall at the distal ends 178 thereof to close the clip receivingchannels. The distal and proximal end portions have outer surfaces. Theouter surfaces of the proximal end portion defines a ramp or cam surface172.

As seen in FIGS. 17, 18, 18A and 18B, the jaws 11A, 11B of theinstrument are described so that they contact at their distal end 178and at primary heel 176 located proximally to the closing ramps 172 ofeach jaw. This is better seen in FIGS. 18 and 18A. As seen in FIG. 17,the jaws 11a, 11b are generally maintained in an open position. Thecontact of the primary heels 176 minimizes the lateral deflection of thearms 172 of the jaws 11A, 11B with respect to support tube 15, toproperly close a clip 8. This initial contact minimizes arm deflectionand torque and supports the system during loading.

When the jaw is fully closed, as seen in FIGS. 18 and 18B, the lastportion of clip closure causes the magnitude of loading conditions toincrease. Two opposing posts positioned on the ends of clip retainingarms 170 of jaws 11A, 11B, 174 called anti-torque posts, contact witheach other near the forming areas of the jaws and counteract the torqueplaced on the jaws. This provides for a more consistent and improvedclip closure. Also, the tips 178 of each jaw contact. Thus, with theanti-torque mechanism described herein, the jaws may be smaller in sizeas they do not need to be as torque resistant. The jaws 11a, 11b alsoprovide improved clip closure mechanism because deflection is minimized.This provides for reliability of the instrument along with minimizationof size.

As seen in FIGS. 19A and 19B, there is described a feeding andescapement system which improves the clip feeding reliability of theendoscopic multiple clip applier 1. This is done by minimizing thepossibility of double feeding of clips into the jaws. The systemconsists of two independent parts. A valve 182 unitary to the clip track4 holds the stack of clips 8 stationary while the forwardmost clip 8 isbiased by lifter spring 3 into the plane of feed bar 9 (Clip 8" ispositioned between jaws 11A, 11B for closure). As the instrument isactuated, the feed bar 9 is caused to retract toward the rear of theinstrument, and from the lifter spring 3. When the feed bar 9 retracts,the ramp 180 on feed bar 9 is engaged with primary valve 182 located inthe clip track 4, thus, clip track 4 is closed.

When clip track 4 is closed, the stack of clips 8 is held stationary. Asthe feed bar 9 retracts further from lifter spring 3, valve 182 isclosed by ramp 180, and lifter spring 3 is actuated, causing the forwardmost clip 8' to be biased into the plane of the feed bar 9 so that itmay be the next clip 8 loaded within the jaw. This is better seen inFIG. 19B. Only one clip 8', however, can be biased toward the feed bar,because the primary valve 182 located in clip track 4 previously usescheck port 184 to hold back any additional clips 8 in the clip stack.The possibility of double feeding of clips is reduced, improving thereliability of the applier.

As seen in FIGS. 20 and 21, there is disclosed a sealing mechanismlocated near the proximal end of the shaft assembly of the endoscopicmultiple clip applier. The sealing mechanism is circular in crosssection and fits tightly through four crushed ribs 196 within the shaftsupport tube 15. Within the sealing mechanism are three chambers 190,192 as identified in FIG. 20, through which the feeding and formingmechanisms of the instrument pass. The primary chamber 190 is an areathrough which a sealant fluid may be injected. Sealant may be insertedthrough insertion holes 194, 198. The outer or secondary chambers 192are provided as spill-over areas for the sealant. This is better seen inFIG. 20. The ends of the sealing mechanism are closed to prohibit themigration of sealant from the chambers 190 to the functional areas ofthe instrument.

The sealing system provides a cushioning mechanism to minimizeinstrument recoil during firing and retraction of trigger 25. Thisclosed sealing mechanism also prevents the intraoperative gross loss ofpressure through the instrument itself, while minimizing, through ribs196, the possibility of instrument functional failure due to sealantmigration. The system is sealed from outside the patient, and it isitself sealed from the moving parts of the instruments.

As seen in FIGS. 22A, 22B and 22C, the triggering system taken inconjunction with FIG. 5 consists of a precock trigger 21, which ispre-stressed and pivots on a post 206 into handle portion 16. Precocktrigger 21 is biased so that there is eliminated any clearance betweenthe precock trigger 21 and the former plate 22 located within the handleportions 16, 28. As the feeder plate 24 is retracted to the rear of theinstrument away from the forming site (FIG. 22B), during handleactuation, a camming surface 296 on the feeder plate 24 contactscylindrical post 298 on the precock trigger 21. This causes the rotationof the precock trigger 21 into its precocked position as seen in FIG.22B.

In its precocked position a projection 200 of the precock trigger 21becomes locked behind a wall 202 extending from the former plate 22. Theprecock trigger 21 now blocks the path of a tab 204 extending fromfeeder plate 24. The feeder plate 24 cannot feed the next clip 8 intothe jaws from this point until the timing wall 202 extending from theformer plate 22 allows the precock trigger 21 to rotate out of the pathof the feeder plate 24. This method of timing causes a sequencingoperation for feeding clips which eliminates the possibility of feedinga second clip into the jaws 11 of the instrument in the event that theinstrument is partially fired and re-opened.

As can be further seen in FIGS. 5 and 22C, torsion spring 20 connects toboth lost motion lever mechanism 18 and anti back-up lever 19. Theobjective of the anti back-up lever 19 is to assure that a pressure isconstantly maintained on the jaws 11 by cam channel 12 as the clip isbeing closed. Anti back-up lever 19 therefore causes cam channel 12 tobe constantly urged forward. This prevents the clip 8 from falling outfrom the jaws 11a, 11b until the applier is fully actuated.

The system is actuated by rotation of the precock trigger 21, so thatthe tab 208 extending from the base of the precock trigger 21 into hole210 of the lost motion lever 18 (and thus connected to the anti back-uplever 19 via torsion spring 20) acts as a toggle mechanism to engage anddisengage the anti back-up lever 19. The hole width 210 of the lostmotion lever 18 determines the relative motion of the precock trigger 21and the lost motion lever 18. This allows timing of the anti back-upactuation mechanism 19 to be adjusted in relation to the actuation ofthe precock trigger 21. The anti back-up lever 19 is constructed of aresilient material and has teeth 214 which engage the metallic teeth 212on former plate 22, as seen in FIG. 5. The anti back-up lever 19 has acam surface which tends to cam the teeth 214 away from former plate 22,in the event that the anti back-up mechanism must be overridden.

As seen FIGS. 9, 10 and 11, there is a tissue stop located as a V notch220 in top shroud 2. This tissue stop is located near the rear end ofthe clip forming area. As seen in FIG. 9, this maintains the clip 8within the forming areas of the jaws 11 and guarantees proper gap sizeof the clips by insuring reliably proper placement of the forwardmostclip 8 within the jaw arms 11A, 11B. It also prevents the possibility oftissue damage by closing the clips too tightly. This feature promotesmore secure clip closure and minimizes the possibility of damage totissue.

As seen in FIGS. 23, 24A and 24B, there is disclosed a ligatingmechanism 200 with a rotational collar 300 attached to shaft 215 andhandle mechanism 216. All of the mechanisms in the clip applyingmechanism 200 are the same as those in clip applying mechanism 1, exceptfor modifications made to the connections between the portions of theclip applier which are maintained within shaft 215, and the connectionsto those portions which are maintained in the handle mechanism 216.These will be further described below.

As seen in FIGS. 24A and 24B, there are described former plate 222 andfeeding plate 224 which are identical to former plate 22 and feederplate 24 of ligating clip applier 1 except for their connections tofeedbar 209 and cam channel 212. This cam channel 212 and feedbar 209are also identical to cam channel 12 and feedbar 9 except for theirconnections with the aforementioned former plate 222 and feeding plate224. Therein, it is seen that ears 224a, 224b are maintained such thatnotches 224c on each of the ears 224a and 224b are maintained aroundcollar 209a. This collar 209a is rotational within the connections 224con feeding plate 224. This rotational connection allows the feed bar 209to rotate in any position with respect to the orientation of the feedingplate 224.

Similarly, ears 222a, 222b correspond to notches 222c on former plate222. These notches 222c fit within a collar 212a on cam channel 212.This allows the circular collar 212a to rotate with any angularorientation about the former plate 222. Thus, cam channel 212 can bepositioned along with feeding bar 209 in shaft 215, regardless of theorientation of handle portion 216. These connections contained inrotational portion 300 allow for the orientation of the ligating clipmechanism in any regard with respect to the handle portion 216.

As seen in FIGS. 24A and 24B, the capability of orientation while adistinctive feature must also allow for firing and loading of theligating clips. This is accomplished in the unique loading and firingmechanism maintained within the coupling of the former and feedingmechanisms.

As seen in FIG. 24A, a spring 302 is in a lengthened position. This isthe generally "open" state of the ligating mechanism 200, and thecoupling 225 which connects feeding plate 224 to feedbar 209 is pushedfully forward. Thus, a ligating clip 8 has been placed between the jaws11 of the clip applier 200. (This occurs in the same fashion as in clipapplier 1.) Now, upon actuation of the mechanism, the feeding plate 224has been moved rearward in the instrument, much as feeder plate 24 ininstrument 1. This causes the feed bar 209 to retract within the shaftsection 215 of the instrument (further causing coupling 225 to retractinto handle 216.)

Simultaneously, former plate 222 is moved forward toward the clippingend of the mechanism. This causes movement of the cam channel 212, tocause the jaws 11 to clinch clips 8. However, because there is relativemotion between the outer and inner mechanisms which connect the formingand feeding systems, the spring 302 is compressed as best seen in FIG.24B. Yet, because the two connections at 224c and 222c are keptseparate, the user is able to feed or fire the mechanism in any angularorientation.

This is novel feature is especially well appreciated when it is realizedthat the user may desire to change the angular orientation of the clips8 at any time during the firing process. This system allows the user todo so, because it allows for any angular orientation of the shaft of theinstrument.

As seen in FIGS. 25, 25A, and 26, the rotating collar 300 is generallycircular, and contains a conical taper from the handle portion 216 tothe shaft 215. Also, at the connection between the handle portion 216and the rotational collar 300, there are detent means 304, which engagethe internal portion of handle 216, at the stops 312. This detentmechanism causes the ligating clip applier to be temporarily restrainedin any one position. However, because the angular orientation of theclip applier may be changed at any time, the detents are notparticularly difficult to overcome. This intentional design function ismade so that the user can reliably be able to rotate the mechanism atany time.

As can be readily realized, the clip applying mechanism 200 appliesclips in the same way as clip applying mechanism 1, except that therotational features of this system allow the user to change positioningof the clip applying mechanism within a trocar cannula 105 at virtuallyany time during the firing process. Indeed, because the firing mechanismand the feeding mechanism operate independent of orientation, thisangular positioning can take place during the closing of the clips. Thisunique feature allows the user to slightly adjust the clip if it isrealized during clip firing that the orientation is not preciselycorrect.

Thus, as can be seen, in operation the mechanisms of this invention allfunction similarly, so that the system is able to operate a closure of aligating clip about a blood vessel. The handle operates to actuate thejaws to close the clip. The various spring and trigger mechanismsoperate to keep the clip adequately supported and provide enough forcefor closing. As has been described, there are numerous safety andredundant systems so that closure is assured. Therefore, while manyobjects and features have been described, the objects of the inventionare to be understood as derived from the attached claims and theirequivalents.

We claim:
 1. An applier mechanism for individually applying a pluralityof surgical closure devices, comprises:a shaft portion; a handleportion; a rotating means extending distally of said handle portion forconnecting said shaft portion to said handle portion so as to permitrotation of said shaft portion about an axis extending longitudinallythrough said shaft portion; applying means positioned in said shaftportion for applying a surgical closure device; feed means positioned insaid shaft portion for delivering a closure device to said applyingmeans; actuation means positioned in said handle portion for actuatingsaid applying means and said feed means; a first connection attachingsaid applying means to said actuation means to permit rotation of saidapplying means with respect to said actuation means upon rotation ofsaid shaft portion by said rotating means; a second connection attachingsaid feed means to said actuation means to permit rotation of said feedmeans with respect to said actuation means upon rotation of said shaftportion by said rotating means; and wherein said first and secondconnections are positioned in said rotating means and rotate about acommon axis extending through said shaft portion and said first andsecond connections are spring biased from one another within said shaftportion.
 2. The device of claim 1 wherein said rotating means isconnected to said handle portion at a third connection, said thirdconnection further including detent means.
 3. The device of claim 1wherein said applying means includes a pair of jaws operated by acamming channel.
 4. The device of claim 1 wherein said feed meansincludes a feed bar placed within said shaft in a position generallyalong the length of said shaft.
 5. The device of claim 1 wherein saidactuation means includes a feeder plate and a former plate.
 6. Thedevice of claim 5 wherein said feeder plate and said former plate eachhave a pair of eared connectors as part of said first and secondconnections.
 7. The device of claim 6 wherein said feed means and saidapplying means are each circular in cross section, and contains notcheson their outer diameter which fit within said two pairs of earedconnectors.
 8. A device for applying a plurality of surgical clipsseriatim, said device comprising:a) an elongated shaft assemblyincluding:(i) a jaw member having at its distal portion a pair of spacedapart jaws for receiving a surgical clip between said jaws, said jawsbeing narrowly configured so that the greatest distance between theouter surfaces of said jaws at their fully open position is relativelythe same as the outer diameter of said elongated shaft assembly, saidjaws having channels in a generally parallel relationship for thereceipt of a surgical clip therein, and said jaw member including a pairof proximally extending spaced apart jaw arms, said jaw arms each havinga primary heel located proximally of said jaws that is defined as ininner surface in each jaw arm which contacts the corresponding innersurface in the opposite jaw arm as the jaws close a surgical clip; (ii)a clip feed mechanism for storing an array of surgical clips anddelivering a clip between said jaws, said clip feed mechanism including:(A) an elongated clip track for housing said array of surgical clips ina first path extending through a first plane with said clips arrangedend-to-end with their legs facing the distal end of the device, (B)spring means for shifting the distal-most clip in said first path out ofthe plane of said first path and into a second path extending through asecond plane generally parallel to the plane of the first path, (C) afeed bar member positioned in said second plane such that proximalmovement of said feed bar member enables said spring means to shift saiddistal-most clip in said first path from said first path into saidsecond path and such that distal movement of said feed bar memberadvances said distal-most clip into a position between said jaws, (D) anescapement member associated with said clip track which is movablebetween (1) a first position extending into said path so as to maintainthe array of clips stationary within said first path, and (2) a secondposition wherein said escapement member is removed from said path toallow distal movement of said array of clips; (iii) a jaw closuremechanism for closing a surgical clip positioned between said jawsincluding a cam channel having an integral jaw engaging mechanism, saidcan channel including a box-shaped element with a pair of lateral sides,a top and a bottom, said lateral sides capable of engaging the outersurfaces of the proximal portions of said jaws and said top having afolded member to complete said box, said folded member being formed as adovetail joint; (iv) a gaseous sealing structure comprising a housingwhich includes a sidewall, endwalls and divider walls which cooperate todefine a central chamber, and end chambers at opposite ends of saidcentral chamber, said end and divider walls including clearance openingsfor accommodating movement of said clip feed mechanism and said jawclosure mechanism, said sidewall having apertures for permitting sealantmaterial to be inserted into said central chamber; b) a handle assemblycontaining actuating means including a single trigger means foractuating both said jaw closure mechanism and said clip feed mechanisms;c) rotating means extending distally of said handle assembly forconnecting said shaft assembly to said handle assembly so as to permitrotation of said shaft assembly about an axis extending longitudinallythrough said shaft assembly; d) a first connection attaching said jawclosure mechanism to said actuating means to permit rotation of said jawclosure mechanism with respect to said actuating means upon rotation ofsaid shaft assembly by said rotating means; and e) a second connectionattaching said clip feed mechanism to said actuating means to permitrotation of said clip feed mechanism with respect to said actuationmeans upon rotation of said shaft assembly by said rotating means;wherein said first and second connections are positioned in saidrotating means and rotate about a common axis extending through saidshaft assembly, and said first and second connections are spring biasedfrom one another within said shaft assembly.